I have a 4mm lesion ("pothole") in my left ankle cartilage. I am 24 and got this injury from a bad ankle sprain and fracture playing basketball after i landed on a foot. I am currently in a boot and told to wait 6 weeks for the fracture to heal, if it does not then they will do the drilling to stimulate some fibercartilage, which i hear is only temporary. Regardless whichever treatment, my docsaid that it would not be a good idea to ever run again.
I am completely devastated, as this has changed my life since I have always been physically active. I know I have not healed yet to even think about possible treatments and scenarios, but i have decided to look ahead.
If i should have no pain after the 6 week period, should i think about pursuing the procedure of drilling even though it does not hurt? I was thinking that this way, it might not be temporary fix since it's a small 4mm lesion. Maybe since it's a small pothole then it will help me more long-term.
Or, if i have no pain, will the 4mm pothole keep getting larger until i suffer from enough pain that I would have to do surgery? Will the pothole continue to get larger even if i take good care of the ankle and dont run on it? Or will the pothole remain almost the same size. And if it does keep degenerating, at what pace/time?
Or, should I try OATS procedure now since it is a very small legion. This way, my knee would have a better chance of healing because they wont need such large amount of tissue to remove. Also, the OATS procedure might raise its rate of success since im young and nipping this problem in the bud before it gets out of hand?
Or, should I take good care of it and hopefully 5 years down the line they find a regeneration formula for permanent cartilage?
I'm not sure what to do. I am so young for this to happen. I am still in the depressed mode and am trying to find any type of hope to get me through this. I have so many questions. I'm going to get a second opinion from another doctor, but i wanted to ask you guys for advice. I hope yall have a great day!
I think it's great you're getting informed on all of this. If I were you I would stay positive and hope for the best. Wait and see what happens in six weeks, hopefully you won't need drilling, also known as microfracture. I wouldn't say microfracture is completely temporary. There are some people it has worked for and have gone back to running. There are also people on here who had that done and it worked for them for 20 years or so before they went ahead with additional surgery. I think that's pretty good. Sure, you're taking a chance, most doctors say it has a 70 percent success rate and that's not what you want to hear. But if I were you I would go conservative first.
I sprained my ankle five years ago, and my lesion was 9mm, so drilling was not the best option for me. I had the OATS procedure 10 weeks ago to fill in my "pothole." They took one plug from my knee. OATS is a big surgery so I saw FIVE doctors to get their opinions on what I should do. I also did a lot of research and felt I would have waisted my time with microfracture for my particular situation. I found a couple of research articles on microfracture and found it typically is not done on lesions greater than 10mm.
As far as will the "pothole" grow? I don't know...tough question. It probably depends on your activity level. I think two doctors I saw said probably not, but three said it would get worse if I left it alone. I didn't want to take a chance so I decided to get it fixed.
So...keep up the research, hope for the best, and get a second and maybe even third opinion if it turns out you need additional surgery. Only a good orthopaedic surgeon will be able to tell you what the best option for you is. If it turns out someday you need the OATS procedure make sure your doctor is experienced in this.
Good Luck to you...
Hey there. I have also had a hard time with this. I first c/o pain about 5 1/2 yrs ago. The OS I saw at the time said I had a 9 x 9mm OCD and did the drilling and debridement procedure (which I now know was really stupid on a lesion of that size). I was NWB x 6 weeks, was sent for no PT and had no restrictions. The procedure seemed to work, but a year (almost exactly) later, I went back to him with c/o pain again. At that time, the lesion had grown to 9 x 13mm. The OS decided to do nothing. I tell you this because you asked about the possible growth or expansion of the "pothole" (very well put, by the way ). Now, while I am not the most active person in the world, I probably have an average activity level. I do not participate in a lot of sports or run, but I do have three children (all in different sports) to chase after and I love to dance. We used to go dancing a lot and this "issue" has put a huge damper on that. Now that you have an idea of the level of activity, I can tell you that when I finally decided to get a second opinion in Oct 08, the MRI revealed an OCD in the same location as before, only it had grown to be 20mm. I know some people, Doctors even, say that these lesions "are what they are" and won't/don't increase in size and I say that is total CRAP!!!!!! I am proof that these things can/do continue to grow. I am not trying to be the bearer of bad news, but what I am saying is don't let this thing go. As Anklehelp stated, get second, third, and even fourth opinions. Do your research and make yourself educated about this topic before seeing the Docs, so you can ask good questions. The good thing is that you caught this at 4mm. At this point, maybe you can still be active and just monitor it with MRI's periodically. That way, if it were to continue to grow, you could do some sort of intervention earlier than most of us have been able to, which would raise the odds of a better outcome. I really wish my old Doc would have taken the "monitor" approach instead of just letting it go. I wish you the best of luck. Keep us posted.
Hi bball,
I went through a similar injury. About 12 years ago I had a bad sprain that didn't seem to get better. Finally had it x-rayed (5 months later) and found out that I had a small fracture and in the bone an cartilage. I was in a cast for 4 weeks and than a supportive brace for almost a year. I was told this was to help the cartilage harden that it would never totally heal and that I may have more issues with it down the road. Up until Jan 09 I hadn't had any issues with it. All of a sudden the pain was back. Went back to my original OS and he said I had an OCD and tried putting me back in a brace also was told to stop horseback riding and dancing and rest the ankle. After a month of the pain getting worse and and MRI showing more than just the OCD was referred to another OS who tried a cortisone shot as a last resort. One week later I scheduled my debreidment and drilling surgery. Surgery was 4-6-09 and found the lesion was only 3mm. Had to do 6 weeks of NWB and just started walking and PT last week. So far things look good. They have told me that once I'm healed I will be able to return to horseback riding and dancing.
I would remain positive about your recovery and hope for the best. Work closely with your OS to make sure that the decisions that you make are the best for your situation. I wish you the best of luck!
Well one thing is for sure and that you ladies love to dance haha . Thank you all for taking the time and providing feedback! This forum's members are very supportive of each other. I am going to try and stay positive as much as i can, but from the looks of things it's probably not a good idea to run again. I wonder if i can just shoot jumpshots (while pushing off my good foot) just by myself...with no running... Something i will have to ask a doctor.
Anklehelp, wow i didnt know that drilling lasted someone here for 20 years. I bet they didn't have an active lifestyle? How did your OATs procedure go? I hope you are recovering pretty well! How do you recommend finding the most experienced specialists in order to get 2nd, 3rd opinions?
dbast, ya i dont know how "active" i can be. Probably swimming, biking, maybe rollerblading (if i can lean on my good ankle more), golf? (if i can somehow not put pressure on my ankle), and some dancing (even though a lot of guys dont need to move around a lot to dance haha). I hope you can continue dancing...but so did u do anything about your 20 mm lesion now?
ahodous, I'm glad your surgery went well! Be careful on it and don't be too active. When they do the drilling, do they leave holes in ur talus or do they leave the screws in there?
Will the pothole get bigger? That was my big question too when I found out about my foot. Unfortunately my pothole started out pretty big so I didn't have the choices you have. The last post said she went 12 years before her foot started bothering her. I would give the 6 weeks a try and be very dilligent to follow Dr.'s orders. Maybe it will work and heal and you can resume most of your activities for many years to come. I would wait and see because there's no going back when you have drilling or OATS. But if after time you have significant pain and can't enjoy life then those operations are an option. 4mm is probably not a choice for OATS - they usually do that surgery for larger lesions. If you ever do get back to running, definitely lessen the impact - no pavement, shorter runs, flat ground. That seems to works well with my foot now. I'm 40 yrs old and had my fun before I hurt my ankle so it makes me sad you're so young with this. But you may get the advantage of on-going technology and that's cool!
Hang in there!
Abby
The drilling makes little holes they hope will fill in with scar tissue and fill up the pothole. The OCD is not filling in on it's own so they try to stimulate it to do so. I think it's 50/50 whether the OCD gets bigger. Mine got to a certain size and then stopped. I do think they get bigger the first year or so after the injury unless someone diagnoses it early like you and gets you in a cast. Most of us on this board were misdiagnosed for a long time and that caused more damage.
Last edited by akirka; 05-28-2009 at 10:11 AM.
Reason: addition
You are lucky you are are catching this early! I believe the pothole will grow!! Mine did for sure. I had the drilling Dec 07 and never recovered. Unforunately - i wouldn't recommend it to anyone but everybody's different as far as healing goes. My MRI a year later (Jan 09) after the drilling showed that the lesion got bigger and the talus was all bruised. In that year i was doing minimal activity (ok well except for dancing ) no running, nothing, and i always walked with a limp. I just had OATS 6 weeks ago and the lesion was even slightly bigger from Jan!! I think it ended up being 9x13mm, they took 2 plugs from my knee. Anyways, my suggesion is to do what the doc says, moniter it, stay away from high impact sports, please go get multiple opinions and find someone who specializes in this!! Before you even see another doctor, I would find out specifically how many procdures the doc has done as far as the drilling and the OATS to find out the experience level. Hang in there and good luck with everything!
I'm doing well post OATS. I feel that I am still early in the recovery though and I'm being patient. I just started weight bearing, so I am still using crutches. I'm at the point in my recovery where I can finally get out more a little more and not be a total couch potato. I've been to the movies a couple of times, I laid out with some friends at the lake the other day, but made sure to lather up my leg with sunblock so I wouldn't get a boot tanline! That would be pretty horrible haha! I'm anticipating I'll get rid of the crutches in two weeks, although I know my walking will be ugly for a while ...Then physical therapy starts. I'm also pretty active but I have avoided high impact activities, which require running and jumping, for some time. I also love to dance , I lift weights, ride a bike, go to spinning classes, yoga, etc. I'm a gym girl. My doctor says I will be able to do all of those things and even run after my recovery. Now, whether I decide to run, that's a different story. Maybe light jogs every once in a while and like Abby says on level surfaces and not on pavement. I will definitely wait a full year before trying any sort of high impact activity though.
As far as finding a good doctor, maybe call the doctors' offices ask to speak to the nurses and get an idea on how many procedures the doctors have done, try to find an orthopaedic surgeon who specializes in ankles, or do google searches for your city's doctors because sometimes people will post reviews. If you know any physical therapists, ask them. They truly know who the best docs in town are. I found one of the best doctors in town that way. I can't even begin to tell you the number of phone calls I made! But then again, I was looking for a doctor who had done a lot of OATS procedures and not microfracture.
Bball - I am now waiting on a donor bone to become available for my OATS procedure to be done. My lesion is too large to be corrected by taking bone from my knee, so I am awaiting the dreaded cadaver bone. I am having a hard time dealing with the frustrations of nothing being done with this earlier and this is why I was saying to monitor yours. I do know that the more conservative treatments can and do work on the smaller lesions and even the OATS procedure has a better success rate on smaller lesions. I agree with Abby in that you wouldn't be a candidate for OATS just yet, but this is where you are a bit luckier than most of us here. Follow your doctors orders EXACTLY like he/she says. Don't create your own version of what they are saying!! I didn't skimp on following orders at all, I did exactly what he told me to....I think he skimped on giving me a correct recovery from the drilling. Like I said, he did not send me for PT and aside from the 6 weeks NWB, there were no restrictions. I think he was a quack!! This is why you research and find the best of the best. I have found that Sports Medicine docs are very familiar with these OCDs, so I would look at the nearest PRO sports team and start with their doctors. I would say, with the right doc on the case you (we) should be able so resume a pretty normal life. Keep your heap up!!
Ya, I will continue to listen to my doctors strictly. On another note, what about nutrition? I have been doing heavy research on types of supplements or organic foods that researchers claim to promote regrowth of cartilage. Here are a few that I found (here are a few excerpts along with the links):
http:// * links to commercial websites, and website information, removed by hb-mod, moderator *
I thought that these might help, but I don't know how well they will do when there is a pothole. When they say "help promote regrowth of cartilage" or "slows down cartilage degeneration", i dont know if they mean this for just old age and osteoarthritis or also for people that just have a pothole from a traumatic injury. Anyways, I thought i would share some of these things. Once again, I am a noobie and all of these quite possibly might mean nothing for our injuries, but it's worth a shot. Lemme know how yall feel about all of these. Thanks, have a great weekend!
Last edited by hb-mod; 05-30-2009 at 05:50 AM.
Reason: Please don't post links and instructions regarding commercial or personal websites as per Posting Policy. Thanks.
bball24, you can't "regrow" your cartilage. cartilage doesn't heal itself. also, you don't need to get the drilling surgery if it doesn't hurt. depending where the pothole is, it may not make contact with surrounding structures--which means it won't bother you. if you do have pain with normal activity....then yes get it fixed. i've seen great results with the procedure in my athletes, but it is a tedious healing process that you have to be very careful with.
shelley
Last edited by shelleybutn; 05-31-2009 at 06:13 AM.
There are some supplements and diets that help regenerate it according to the research i dont (obviously cant post the links cuz of the "Posting Rules").
Chondroitin and Glucosamine are two of the main components of cartilage. I remember reading that there are some supplements that contain these two things that help in the healing and regeneration of cartilage. Most likely i think it will help with any further deterioration. Lemme know if you guys have heard of any of these being helpful.
Here are some others that i looked up that help with regeneration and/or further damage...collagen hydrolysate, avocado-soybean unsaponifiable, and wheatgrass.
cartilage does not regrow itself. the drilling procedure fills in with scar tissue that will mimmick cartilage...doesn't actually grow in cartilage. i think the supplements are supposed to help "lubricate" the joints, not grow cartilage
shelley
Last edited by moderator2; 05-31-2009 at 04:17 PM.
Reason: please read the posting rules
Bball,
From what I know there is conflicting evidence on whether or not glucosamine and chondritin help cartilage. I've been taking the supplement for two years and while I'll never know if it slowed down my lesion from growing, I say why not give it a shot? Several doctors have told me there is no supporting evidence that it works yet they still recommend it, so I'll continue taking it.
Unfortunately I don't think supplements work too well to heal your OCD since damaged cartilage is kind of a permanent thing. The main problem is the loss of a smooth joint surface so even if the cartilage could grow it may not have that same smoothness. After my OATS surgery my osteotomy (where they cut bone) was healing a little slow and I added calcium to my diet with great results. It filled in within 10 days after that. I was amazed!! Supplements may not help but who knows, they can't hurt at least!
Ya, that makes sense...but hey, it cant hurt...and it will have a placebo affect in my mind, making me think that it's working so that I wont have to worry about it so much lol . How did your OATS procedure go? i remember you said that you can run again now..but not long distances. Do you consider the surgery a success???
I think everyone is kinda on the right tract with the fact that there are a lot of conflicting evidence as to how they work and do they work. I have always had it explained to me as that products such as glucosamine and chondroition can help reduce the inflammation in the joint therefore causing less pain. They are also believe to help the healthy tissue that is there but will not necessarily regrow cartilage. Also another supplement that I have done a lot of reading on is the HA which is a component of cartilage and the synovial fluid. This is believed to lubricate the joint and also reduce inflammation.
It doesn't hurt to try and see if it will help reduce your pain and inflammation. I have used them and noticed a difference with them.
I dunno, well i just hope the "conflicting evidence" goes in our favor whether we realize it or not. I had a couple questions to ask you ladies (since i seem to be the only guy in this thread haha).
You guys talked about how you are able to resume "normal activities", but what exactly does that mean? What kind of exercises or normal routinely activities do you guys perform with yalls OCDs. Do you do short jogs to a certain part of the room if it calls for it? Or do u avoid anything that is not considered walking?
Also, I am 24 and used to weigh 200 lbs (mostly muscle), but now dropped it to 190 and plan to drop it to 180. I can't go any further down because I am naturally a big guy. I am going to be putting a lot more pressure on my foot than you ladies, safely assuming that men weigh more than women. Is everybody's cartilage in that part of the ankle region the same thickness and surface area regardless of your sex or body type? I hope not, because I will be at a major disadvantage :-(.
Yea, not only are we mostly ladies but we're all the exact same age. A very interesting statistic on this injury .....
The last time I saw my OS she was so happy that my OATS was a huge success. She said she had sent another one of her OCD patients to the same surgeon I went to but she was worried about his outcome because he was such a big guy. I said maybe he would lose weight and she explained he wasn't heavy, just a big man - tall, muscular. She gave me the impression that the smaller and lighter you are the less stress on your joint (which makes sense) and the better your joint can handle the impact. So, I'm sure your joint cartilage size is proportional to your body, but I don't think it's any thicker than someone weighing 130 lbs. I never thought about that until now...
I think most of us ladies were fairly active - runners, hikers, skiers, martial arts - definitely not couch potato and active beyond 'normal activites'. After our injuries, normal activites like walking and standing became very painful and led us to treatment. So I personally can say I'm satisfied with being able to walk, stand, be on hard surfaces, garden, wear shoes -simple things with no pain. Beyond that, I'm doubly blessed to be able to hike, jog, play volleyball - thoses are extra perks that I'm careful not to do too much and definitely protect my ankle!
Wait and see what happens in six weeks, hopefully you won't need drilling, also known as microfracture. I wouldn't say microfracture is completely temporary. There are some people it has worked for and have gone back to running. There are also people on here who had that done and it worked for them for 20 years or so before they went ahead with additional surgery. I think that's pretty good. Sure, you're taking a chance, most doctors say it has a 70 percent success rate and that's not what you want to hear. But if I were you I would go conservative first. 
). Now, while I am not the most active person in the world, I probably have an average activity level. I do not participate in a lot of sports or run, but I do have three children (all in different sports) to chase after and I love to dance. We used to go dancing a lot and this "issue" has put a huge damper on that. Now that you have an idea of the level of activity, I can tell you that when I finally decided to get a second opinion in Oct 08, the MRI revealed an OCD in the same location as before, only it had grown to be 20mm. I know some people, Doctors even, say that these lesions "are what they are" and won't/don't increase in size and I say that is total CRAP!!!!!! I am proof that these things can/do continue to grow. I am not trying to be the bearer of bad news, but what I am saying is don't let this thing go. As Anklehelp stated, get second, third, and even fourth opinions. Do your research and make yourself educated about this topic before seeing the Docs, so you can ask good questions. The good thing is that you caught this at 4mm. At this point, maybe you can still be active and just monitor it with MRI's periodically. That way, if it were to continue to grow, you could do some sort of intervention earlier than most of us have been able to, which would raise the odds of a better outcome. I really wish my old Doc would have taken the "monitor" approach instead of just letting it go. I wish you the best of luck. Keep us posted.
Something i will have to ask a doctor. 
...Then physical therapy starts. I'm also pretty active but I have avoided high impact activities, which require running and jumping, for some time. I also love to dance 
. How did your OATS procedure go? i remember you said that you can run again now..but not long distances. Do you consider the surgery a success???
